Breast Cancer Treatment Increases Cardiovascular Risks in Survivors

​​By staff

Columbus, OH—While the cure for breast cancer isn’t worse than the disease, healthcare professionals need to be aware of the long-term risks associated with it.

That’s the gist of a new scientific statement from the American Heart Association, published in the journal Circulation. It addresses the increased risk of cardiovascular disease, including heart failure, faced by some patients treated for breast cancer.

The writing group urges a treatment approach that takes into account potential heart damage when determining specific therapies to combat the cancer.

According to the statement, breast cancer survivors, especially those older than age 65 years, are more likely to die from cardiovascular disease than breast cancer, which makes managing heart disease risk factors especially critical.

“Any patient who is going to undergo breast cancer treatment, whether they have heart disease at the beginning or not, should be aware of the potential effects of the treatments on their heart,” explained Laxmi Mehta, MD, chair of the writing group for the new scientific statement and an associate professor of medicine at The Ohio State University. “This should not deter or scare patients from undergoing breast cancer treatment but should allow them to make informed decisions with their doctor on the best cancer treatment for them.”

The report raises concerns about several breast cancer therapies, including:

• HER-2 targeted therapies, which can cause weakening of the heart muscle, leading to heart failure. While the reduction in strength might be temporary in some patients, it is permanent in others. Understanding that can help clinicians monitor heart health and slow down or alter treatment to avoid permanent heart failure, the statement points out.• Doxorubicin, a chemotherapy agent that can damage heart cells, might be less dangerous to the heart when administered slowly instead of all at once.• Anthracyclines, which can result in abnormal heart rhythms that in some patients are benign but in others can lead to life-threatening heart rhythms • Antimetabolites, which can cause spasm of the heart arteries, leading to chest pain and even heart attacks in some cases• Radiation, which can affect the heart arteries and cause the development of coronary artery disease or blockages

The scientific statement also calls for more studies on dexrazoxane, which reduces cell damage and has recently been approved for patients with metastatic breast cancer who receive high doses of doxorubicin.

“Fortunately, with the advances in breast cancer treatment, there has been a growing number of survivors,” Mehta said. “However, during and after the treatment of breast cancer, having optimal control of heart disease risk factors is important, because older breast cancer survivors are more likely to die of heart disease than breast cancer.”